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J � APPLICA�T'IC'"1 FOR CONSTRUCT'�N PERMIT � <br /> ,1�� , TO BE COMPLETED IN BLRCK INK—PLEASE PRINT <br /> S� � <br /> HEATING SYSTEM: ' GAS ❑ELECTRIC ❑ —� <br /> BUILDING DEPARTMENT <br /> 259-8810 �/- <br /> ❑ DEMOLITION I_] COMBINATION I 1 BUILDING '.�nECHANICAL Ll PLUMBING Ll SIGN <br /> OWN R MAILADDRE55 CITY ZIP PMON[ � — _ ��� <br /> �-- �1;� �tx� �Ic � U��,�> �.,�" ,��� Sa <br /> iENANT MFIIADDRESS CItV ZIP PHONE <br /> pRLNITECTOR�E5IGNER MAtIAD�RESS Cltt ZIP PNONE <br /> GENERRIGONTRACTOR MAILADDFE55 <br /> GTY ZIP PNONE STATELICENSE� <br /> ME HANICAL LONTRACTOR MRIL�ODRESS CITV 2�P PMONE SiATE LICENSE• <br /> � �n��n unl�s al �1 (�i(���� �`'�' �-unnr ntzx( �� �'S- 7yc� ��1�/1�1N,./��SI(3c- <br /> PLUMBI G CONTRACTOR � �AIL ADDRESS CITY ZIP PMONE STATE LICENSE t <br /> CONTRACT PRICE OP WORtt L ,`� <br /> / / �V \ <br /> DESCRIBEWOFKANOSOUAREFOOTAGEINVOLVE� CONTACTPERSONANOPMONENO ��— ���, �]2//� <br /> /U \ <br /> � 1 � � — <br /> 5 <br /> I� 1 ' i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF 9UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.ALL <br /> 5��� PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS NPE OF <br /> IEGPLDESGRIPTIONGFPROPEFTYISNOWNBEIOWORATTACMTWOCOPIES) WORK WILL BE COMPLETED WI7H WHETHER SPECIFIED HERFIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> ioi eiocK oF AU7HORITY TO VIOLATE OR CANCEL THE PROViSIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN i CONSTRUCTION OR?HE <br /> PERFORMANCE OF CONSTRUCTION.THAi I AM AUTHORIZED BY THE <br /> OWNEFi OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS NiADE AND I COMPLY WITH THE STATE <br /> PAPCEL TA%I D.NUMBER CONTRACTORS LAW 18.27 RGW AND 296200 WAC. <br /> G N15TFUCTION LOAN LEND@R ADDRE55,TELEPHONE NUMBER 1� � � „ � / � <br /> � � <br /> SIGNALME G / D�1E <br /> PROJECT ADDflES , (� / , -- <br /> ` QIiVOU$MC$$l�C[NSENO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR�TEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A/C—A/HNDLG C��ITS—H.P. <br /> . BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> � CLOTHES DRYERS <br /> SHOWER - � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN ,_.�— <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY ' WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> UF!NAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT ' <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING __�— <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � � <br /> SUB TOTAL S <br /> SUB TOT�L $ � ' <br /> PERMIT S PERMIT $ 7 � <br /> TOTALFEE 5 TOTALFEE 5 <br /> FOR OFFICE USE ONLY: REcurr No <br /> FRONTSETBRCK <br /> PEAR SETB/CK SID[SETBACK PLhN CMECN NUMBER FEE <br /> USEZONE <br /> �pTqqEq vncnNTsrce FEES VALUATION FEE <br /> l'_'i YES C�I NO BUILDING <br /> rvPFOFLONSi. ND.OFSTORIES occwFecr xoaoxtwNcuxns <br /> GnWP pLUMBING <br /> i <br /> SREOFBLDG. FlRESPIIMKLERSREO'D BASEMENT MECHANICAL <br /> G YES ❑ N� <br /> OCCUPANCYlOAD FlREALAPMREOD HEIGNTUMITATION <br /> ADDITIONAL PLAN CNECK ' _ <br /> OTHEfi <br /> REn50N STATE BUILDING SUFCHAR�E <br /> INTRKEBY f'LANSAPPROVEDBY CITYOFEVERETT PUBLICWORNS ��� <br /> LOCALSALES <br /> DAi[ <br /> TAX CODEIS 3105 TOTAL <br />